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MIDS 197 > Ch 6 Parasternal Measurements > Flashcards

Ch 6 Parasternal Measurements Flashcards

1
Q

Measurements are most accurate using what type of resolution?

A

Axial (along length of beam)

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2
Q

Most measurements are obtained during what part of the cardiac cycle?

A

-End diastole
-End systole

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3
Q

Are most measurements taken when the valves are open or closed?

A

Closed

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4
Q

List 4 ways in which we can identify that our image is in end diastole?

A

-Largest LV volume
-Smallest atrial volume
-At R wave on ECG
-Frame at MV closure (m/c)

(IVS is thinner, LV is relaxed)

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5
Q

List 4 ways in which we can identify that our image is in end systole?

A

-Smallest LV volume
-Largest atrial volume
-At end T wave on ECG
-Frame at AoV closure (m/c)

(IVS is thicker)

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6
Q

How do our measurements affect pt care + their outcomes?

A

Accuracy = repeatability
Incorrect measurements = potentially incorrect diagnosis/treatment

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7
Q

How can we avoid over or under estimating our measurements?

A

Imagine an imaginary line cutting through out structure in SAG, our measurement must be perpendicular to this line to be accurate (if not then we will be oblique)

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8
Q

What 2 things can help us get more accurate measurements in PLAX?

A

-Heel/toe probe to get LV flat
-Angle to get rid of pap muscles + chords

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9
Q

Should we measure each chamber/structure in our image with the same angle?

A

No, each has a different angle unique to that structure

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10
Q

Why do we measure structures in echocardiography?

A

-To assess for changes in heart size due to pathologies
-To monitor cardiac abnormalities

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11
Q

We are learning measurements + reference values off of what company?

A

American Society of Echocardiography

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12
Q

How do we measure the IVSd?

A

-Vertically from RV side of IVS to LV side of IVS
-Don’t include RV trabeculations
-Be perpendicular to long axis of LV, just past MV leaflet tips
-Measure in end diastole (when all valves closed)

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13
Q

What is the pitfall when measuring the IVSd?

A

Accidentally including the RV trabeculations in our measurement

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14
Q

What is normal IVSd measurement?

A

M: 0.6-1.0cm
F: 0.6-0.9cm

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15
Q

If we go to measure the IVSd and we notice a sigmoid septum, how do we measure this?

A

-Avoid measuring the bulge of the IVS
-Measure just after bulge

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16
Q

What is a sigmoid septum caused by?

A

Age related changes of the heart (is a thick IVS)

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17
Q

In cardiac, do we tend to measure the thickest area of a structure or an area with more continuous size?

A

Area of more continuous size, to take a representation of the average

(think it is the opposite of general u/s)

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18
Q

How do we measure the LVIDd?

A

-Vertically from endocardium of IVS to endocardium of LVPW
-Perpendicular to long axis of LV
-Measured in same frame as IVSd

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19
Q

What measurement provides the 1st measurement of our Teicholtz ejection fraction calculation?

A

LVIDd

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20
Q

Normal value of LVIDd?

A

M: 4.2-5.8cm
F: 3.8-5.2cm

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21
Q

What is a pitfall when measuring the LVIDd?

A

-Not measuring passed pap muscle/chord + including it in our measurement (including these assumes that these structures exists circumferentially)

-Not being perpendicular to our imaginary axis line (being 90 degrees to it is most accurate)

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22
Q

How to measure the PWd?

A

-Vertically from endocardium of LVPW to epicardium
-Measure in same frame as IVSd + LVIDd

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23
Q

Normal value of PWd?

A

M: 0.6-1.0cm
F: 0.6-0.9cm

(same as IVSd)

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24
Q

How to measure the LVIDs?

A

-Perpendicular to long axis of LV
-Measure at end systole (same beat as end diastolic measurement of LVIDd)
-Vertically from endocardium of IVS to endocardium of PW

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25
Q

What measurement provides the 2nd measurement of our Teicholtz ejection fraction calculation?

A

LVIDs

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26
Q

Normal value of LVIDs?

A

M: 2.5-4.0cm
F: 2.2-3.5cm

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27
Q

Normal EF range?

A

M: 52-72%
F: 54-74%

28
Q

Why do females have a higher EF range?

A

B/c they have a larger difference b/w the LVIDd + LVIDs

29
Q

What is ejection fraction by teicholz?

A

Estimate of LV systolic function via % of blood volume ejected with each occurrence of systole (during each cardiac cycle)

30
Q

What is fractional shortening?

A

-Rough estimate of LV systolic function
-Measures contractility + inward motion of endocardium

31
Q

Is fractional shortening still used in clinical practice?

A

Rarely

32
Q

Normal range of fractional shortening?

A

25-45%

(typically half of EF)

33
Q

How to measure the AoR?

A

-Measure at end diastole in front of closed valve
-Zoom into AO to optimize
-Leading edge to leading edge (outer to inner)
-Perpendicular to wall of AoR

34
Q

Other names for AoR measurement?

A

-Sinus of Valsalva
-AO diameter

35
Q

Normal value of AoR?

A

M: 3.1-3.7cm
F: 2.7-3.3cm

36
Q

Pitfall of AoR measurement?

A

Measuring too close to AoV annulus, this will underestimate this parameter

37
Q

How to measure LVOT?

A

-Zoom in on AO to optimize
-Measure at mid systole with valve open
-Inner edge to inner edge
-0.5cm up to 1cm away from AoV
-Measure perpendicular to LVOT

38
Q

What is the 1st measurement required for AoV calculation?

A

LVOT

39
Q

What is the only measurement we take with the valve open?

A

LVOT

40
Q

Normal value for LVOT?

A

1.8-2.2cm

41
Q

How to measure asc AO?

A

-Acquire in HPLAX (decrease depth to only asc AO)
-Measure in end diastole
-Leading edge to leading edge (outer to inner) in most distal portion we can see
-Measurement is perpendicular to plane of AO

42
Q

Normal value of Asc AO?

A

M: 2.6-3.4cm
F: 2.3-3.1cm

43
Q

Is the ascending AO measurement done at the most proximal or distal part seen in HPLAX?

A

Distal

44
Q

How to measure the LAs?

A

-At end systole with valves closed
-Vertically from leading edge of the posterior wall of AoR to leading edge of posterior wall of LA wall
-Use sinus of valsalva as a guide of where to measure
-Measure perpendicular to plane of LA

45
Q

Normal value of LAs?

A

M: 3.0-4.0cm
F: 2.7-3.8cm

46
Q

How to measure the RVOT?

A

-At PSAX AoV typically
-End diastole
-Inner to inner
-All valves closed

47
Q

How to measure the RVOT proximally + distally?

A

Prox: anterior RV wall to AoV (to the top of the screen)

Dist: anterior RV wall to AoV, just proximal to PV
(to the right side of screen)

48
Q

Normal value of RVOT proximal measurement?

A

2.1-3.5cm

49
Q

Normal value of RVOT distal measurement?

A

1.7-2.7cm

50
Q

LV mass is a risk factor + strong predictor of what?

A

Cardiovascular events

51
Q

List 3 different methods for calculating LV mass?

A

-2D linear
-M mode
-3DE

(all convert volume to mass by multiplying volume of myocardium by myocardial density (1.05g/mL))

52
Q

LV mass formula?

A

LV mass = 1.05 (total volume - chamber volume)

53
Q

LV mass varies depending on what factors?

A

-Gender
-Age
-Body size
-Obesity
-Region in world

54
Q

LV mass is higher in men or women?

A

Men (also increases with body size)

55
Q

LV mass measurements are indexed to what?

A

BSA

56
Q

LV mass normal value?

A

M: 49-115 g/m^2
F: 43-95 g/m^2

57
Q

What is relative wall thickness?

A

Simpler measure of ventricular geometry with pt’s with hypertrophy of myocardium

58
Q

What does relative wall thickness show?

A

Relationship b/w wall thickness + cavity size

59
Q

Normal value of relative wall thickness?

A

0.32-0.42

60
Q

How is relative wall thickness calculated?

A

By doubling the dimension of the PW + dividing by the LV diastolic dimension

RWT = (2 x PWd) / LVd

61
Q

What is normal geometry?

A

Normal LV mass + RWT

62
Q

What is concentric hypertrophy?

A

-Increased LV mass + RWT

63
Q

What is eccentric hypertrophy?

A

Increased LV mass + normal RWT

64
Q

What is concentric remodeling?

A

Normal LV mass + increased RWT

65
Q

Give an example of concentric hypertrophy?

A

Aortic stenosis (small chamber + thick walls), causing LV pressure overload

66
Q

Give an example of eccentric hypertrophy?

A

Aortic regurgitation (dilated chamber with normal wall thickness, increased total weight of ventricle), causing chronic volume overload

67
Q

Give an example of concentric remodelling?

A

Hypertensive heart disease

MIDS 197 (15 decks)

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